ED Toolkit for Opioid Use Disorder
The goal of the META:PHI ED Toolkit for Opioid Use Disorder is to provide the resources necessary for a prescriber in any emergency department in Ontario to initiate buprenorphine when appropriate, along with additional materials to support all ED staff in providing evidence-based care for patients with opioid use disorder.
The recommendations provided in this toolkit are intended for informational purposes only. The recommendations in these documents represent the views of the authors, arrived at after careful consideration of the available scientific evidence and external expert peer review. Best efforts were made to ensure that the information in this set of documents is accurate. Clinicians and other readers must determine the appropriate clinical care for each individual patient on the basis of all the clinical data available for the individual case. The META:PHI program at Women’s College Hospital and every person involved in the creation of this publication disclaim any warranty as to the accuracy, completeness, or currency of this publication. Guideline users are always urged to seek out the most current information available that might impact the recommendations contained within a guideline. The META:PHI program at Women’s College Hospital expressly disclaims any responsibility or liability for damages, loss, injury, or liability resulting from reliance on information within this guide.
This toolkit was inspired by the CA Bridge 
program.
Prescriber information
This flowchart provides an algorithm for determining the appropriate intervention for patients in opioid withdrawal in the emergency department (ED).
Part of ED toolkit for OUD
Version date: 28 March 2025
This flowchart provides an algorithm for a standard buprenorphine (Suboxone) initiation in the emergency department (ED).
Part of ED toolkit for OUD
Version date: 28 March 2025
A short guide to managing patients in opioid withdrawal in the emergency department (ED).
Part of ED toolkit for OUD
Version date: 28 March 2025
A short guide to high-dose buprenorphine (Suboxone) initiation (macrodosing) in the emergency department.
Part of ED toolkit for OUD
Version date: 7 February 2024
A decision-making tool for high-dose buprenorphine (Suboxone) initiation (macrodosing) in the emergency department.
Part of ED toolkit for OUD
Version date: 7 February 2024
A guide for emergency department (ED) clinicians about initiating buprenorphine (Suboxone) in the ED.
Part of ED toolkit for OUD
Version date: 7 February 2024
Responses to some frequently asked questions about initiating buprenorphine (Suboxone) in the emergency department (ED).
Part of ED toolkit for OUD
Version date: 7 February 2024
A short guide for community providers on prescribing buprenorphine (Suboxone) to patients with opioid use disorder (OUD).
Part of ED toolkit for OUD
Version date: 7 February 2024
A decision-making tool for initiating methadone in the emergency department.
Part of ED toolkit for OUD
Version date: 28 March 2025
Templates
A checklist for emergency department (ED) clinicians when asking a patient about their substance use.
Part of ED toolkit for OUD
Version date: 12 January 2022
A sample order set for managing opioid withdrawal in the emergency department (ED).
Part of ED toolkit for OUD
Version date: 28 March 2025
A sample order set for managing opioid withdrawal in the emergency room (ED)
Part of ED toolkit for OUD
Version date: 28 March 2025
A sample order set for managing opioid withdrawal in the emergency department (ED)
Part of ED toolkit for OUD
Version date: 28 March 2025
A sample order set for providing methadone or slow-release oral morphine (SROM, Kadian) in the emergency department (ED).
Part of ED toolkit for OUD
Version date: 28 March 2025
An order set for emergency department (ED) buprenorphine (Suboxone) initiation, both standard and macrodosing.
Part of ED toolkit for OUD
Version date: 28 March 2025
An order set for emergency department initiation of methadone.
Part of ED toolkit for OUD
Version date: 7 February 2024
The Clinical Opioid Withdrawal Scale (COWS) is a validated scale for measuring opioid withdrawal severity.
Part of ED toolkit for OUD
Part of RAAM clinic toolkit
Version date: 19 September 2022
Pain Assessment and Pharmacologic Management, by C. Pasero and M. McCaffery, 2011, St. Louis, MO: Mosby/Elsevier. Copyright (1994) by Chris Pasero.
Part of ED toolkit for OUD
A template for an outpatient methadone prescription after emergency department discharge.
Part of ED toolkit for OUD
Version date: 7 February 2024
A template for an outpatient prescription for buprenorphine (Suboxone) after initiation in the emergency department (ED).
Part of ED toolkit for OUD
Version date: 28 March 2025
A prescription template for home initiation of buprenorphine (Suboxone) after emergency department (ED) discharge.
Part of ED toolkit for OUD
Version date: 7 February 2024
A prescription template for home microdosing initiation of buprenorphine (Suboxone) after emergency department (ED) discharge.
Part of ED toolkit for OUD
Version date: 7 February 2024
A RAAM clinic referral template for patients being discharged from the emergency department (ED).
Part of ED toolkit for OUD
Version date: 28 March 2025
Administrative resources
A sample application form to add buprenorphine (Suboxone) to the emergency department (ED) formulary.
Part of ED toolkit for OUD
Version date: 7 February 2024
Sample policies and procedures for providing take-home naloxone kits to emergency department (ED) patients who are at risk of opioid overdose.
Part of ED toolkit for OUD
Version date: 1 April 2021
A sample medical directive authorizing emergency department (ED) staff to provide take-home naloxone to patients at risk of opioid overdose.
Part of ED toolkit for OUD
Version date: 1 April 2021
Part of ED toolkit for OUD
Version date: 1 April 2021
Information for emergency department (ED) staff on how language, behaviour, and attitudes can convey stigma towards people who use drugs.
Part of ED toolkit for OUD
Version date: 1 April 2021
Patient materials
A patient handout about buprenorphine (Suboxone) treatment.
Part of ED toolkit for OUD
Version date: 7 February 2024
A patient handout about microdosing buprenorphine (Suboxone) initiation.
Part of ED toolkit for OUD
Version date: 7 February 2024
A patient handout for starting buprenorphine (Suboxone) at home.
Part of ED toolkit for OUD
Version date: 7 February 2024
Instructions on naloxone use for printing and inserting in take-home naloxone kits. Created by CATIE.
Part of ED toolkit for OUD
Version date: 1 April 2022
Taliesin Magboo Cahill RN MSN
Justin Jek-Kahn Koh MD MPH FRCPC
Jean-Paul Michael, Emergency Department Addiction Case Manager
Larry Nijmeh MD CCFP (EM) FCFP
Hasan Sheikh MD CCFP (EM)
Elizabeth Shouldice MD MPH CCFP (EM) FCFP
Anita Srivastava MD MSc CCFP
Jennifer Wyman MD FCFP DABAM MPH
Lisa Bromley MD CCFP (AM) FCFP
Ruben Hummelen MD CCFP
Meldon Kahan MD CCFP FRCPC
Michelle Klaiman MD FRCPC DABAM
Helen Manohararaj MScN NP-PHC ENC (C)
Louisa Marion-Bellemare MD CCFP
Lisa Roth MD CCFP
Julie Samson MD FRCPC
Amit Shah MD CCFP (EM) FCFP
James Brokenshire MD CCFP (EM)
Calvin Chan MD CCFP
Katie Dunham BSc Hons BScN MN NP-PHC
Jonathan Gravel MD CCFP (EM)
Nour Khatib MD CCFP (EM)
Kate Lazier MD CCFP (EM) FCFP
Brodie Marshall MD CCFP (EM)
James McGorman MD CCFP (EM)
Robyn Nocilla BScN MSc NP-PHC
Don Sangster MD CCFP (EM)
Erika van Daalen MD CCFP (EM) FCFP
Shaun Visser MD CCFP (EM)
Jim Yang MD FRCPC
Max Zworth MD FRCPC